Provider Demographics
NPI:1538303771
Name:SPARKS, SHERELL MARIE (MS, CRC)
Entity Type:Individual
Prefix:
First Name:SHERELL
Middle Name:MARIE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 WHAM DR
Mailing Address - Street 2:SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-4313
Mailing Address - Country:US
Mailing Address - Phone:618-453-7123
Mailing Address - Fax:618-453-7178
Practice Address - Street 1:625 WHAM DR
Practice Address - Street 2:SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-4313
Practice Address - Country:US
Practice Address - Phone:618-536-2122
Practice Address - Fax:618-453-7178
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator